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Flashcards in RESP: asthma Deck (21)
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1
Q
A
2
Q

Presentation of asthma:

a) Symptoms?
b) Signs?

A
a) Symptoms: 
Wheeze
Dyspnoea
Cough (may be nocturnal)
Chest tightness
Diurnal variation (symptoms often worse in the morning)
b) Signs:
Tachypnoea
Hyperinflated chest
Hyper-resonance on chest percussion
Decreased air entry (sign of severe illness: silent chest)
Wheeze on auscultation
3
Q

Investigations for suspected asthma?

A
  1. Peak flow: variability >20%
  2. Fractional exhaled nitric oxide (FeNO): >40 ppb in adults or >35 ppb in children
  3. Spirometry with bronchodilator reversibility: FEV1/FVC < 0.7 (obstructive spirometry). Improvement of FEV1 > 12% after bronchodilator therapy is diagnostic
  4. Bloods - FBC, U+Es, ABG
  5. CXR
4
Q

Non - pharmacological management of asthma? (not an acute attack)

A

Smoking cessation
Avoidance of precipitating factors (eg. known allergens - dust, animal hair, cold air etc)
Review inhaler technique

5
Q

Pharmacological management of asthma? (not an acute attack)

A

Step 1: short-acting inhaled B2-agonist (eg. Salbutamol)
Step 2: add low-dose inhaled corticosteroid steroid (ICS)
Step 3: Long-acting beta-2 agonists (e.g., salmeterol) or maintenance and reliever therapy (MART)
Step 4: Increase the inhaled corticosteroid or add a leukotriene receptor antagonist (e.g., montelukast)
Step 5: Specialist management (e.g., oral corticosteroids)

(modified 19/2/24- info from BTS guidelines and Z2F)

6
Q

Investigations for acute asthma attack?

A

ABG: type 2 respiratory failure (low PaO2 and high PaCO2) is a sign of a life-threatening attack.

Routine blood tests (including FBC, CRP): to look for precipitating causes of an asthma attack, such as an infection.

Chest x-ray: to exclude differentials and possibly identify a precipitating infection.

7
Q

Management of acute asthma attack?

A
  • ABCDE - Ensure a patent airway
  • Ensure oxygen saturations of 94-98%, ABG if O2 sats <92%
  • Nebulisers: Salbutamol 5mg (can repeat after 15mins).
  • Steroids: oral Prednisolone 40mg STAT or IV Hydrocortisone (if PO not possible)
8
Q

Differential diagnosis for asthma?

A
Bronchiectasis 
COPD 
CF 
Foreign body aspiration (especially in children)
GORD 
HF 
Interstitial lung disease 
Lung cancer 
Pertussis
9
Q

Characteristics of asthma? i.e. what is it?

A

Chronic inflammation disease of the airways
Obstructive but reversible (spontaneously or w treatment)
Increased airway responsiveness (i.e. narrowing) to variety of stimuli.

10
Q

Pt has a wheeze. What are most likely/common differentials?

A

Acute asthma exacerbation
Bronchitis - bacterial or viral

Less common:
Pulm oedema 
PE
GORD
Allergy 
Hyperventilation
Cardiac disease 
Churg-Strauss syndrome
11
Q

Define MILD asthma exacerbation based on:

1) PEFR %

2) features of severe asthma

A

1) >75%

2) no features of severe asthma

12
Q

Define MODERATE asthma exacerbation based on:

1) PEFR %

2) features of severe asthma

A

1) 50-75%

2) no features of severe asthma

13
Q

Define SEVERE asthma exacerbation based on:

1) PEFR %

2) features of severe asthma

A

1) 33-50%
2) Cannot complete sentences in one breath
RR>25
HR>110

(ANY ONE OF THESE PRESENT = SEVERE ASTHMA ATTACK)

14
Q

Define LIFE THREATENING asthma exacerbation based on:

1) PEFR %

2) features of severe asthma

A

1) <33%
2) Sats<92% or ABG pO2<8kPa
Cyanosis, poor response effort, silent chest
Exhaustion, confusion
Hypotension, arrythmias
normal pCO2

15
Q

Define NEAR FATAL asthma exacerbation based on features of severe asthma

A

RAISED pCO2

16
Q

Management of SEVERE (PEFR 33-50%) asthma attack?

A

Same as acute asthma attack

  • ABCDE - Ensure a patent airway
  • Ensure oxygen saturations of 94-98%, ABG if O2 sats <92%
  • Nebulisers: Salbutamol 5mg (can repeat after 15mins).
  • Steroids: oral Prednisolone 40mg STAT or IV Hydrocortisone (if PO not possible)

PLUS:

  • Nebulised ipratropium bromide 500micrograms
  • back to back salbutamol if needed
17
Q

Management of LIFE THREATENING (PEFR <33%) asthma attack?

A

Same as acute asthma attack PLUS

  • urgent ITU or anaesthetist assessment
  • Urgent portable CXR
  • IV aminophylline
  • Consider IV salbutamol if nebuliser route is ineffective.
18
Q

Criteria for safe asthma discharge after exacerbation?

A

PEFR >75%
Stop nebulisers 24hrs before discharge
Inpatient asthma nurse review to reassess inhaler technique and adherence
Provide PEFR meter and written asthma action plan
At least 5 day course of oral prednisolone
GP follow up within 2 working days
Resp clinic follow up within 4 weeks
Psychosocial factors considered before discharge

19
Q

Differentials of eosinophilia?

A
Airway inflammation = COPD or asthma 
Hayfever/allergies 
Multiple courses of abx for chronic infections 
Eosinophillic pneumonia 
Parasites 
Lymphoma 
SLE
20
Q

Asthma triggers?

A
Smoking 
Cold air 
Allergens - dust, pollen, pets
URTI - mainly viral
Occupational irritants
Pollution 
Drugs - aspirin, Bblocker
Food and drink - dairy, alcohol, orange juice
Stress
21
Q

How to manage chronic asthma?

A

Use BTS stepwise management guidelines
Assess and teach inhaler technique
Self management plans
Avoid triggers

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